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Öğe 99mTc sestamibi muscle scintigraphy to assess the response to neuromuscular electrical stimulation of normal quadriceps femoris muscle(Springer-Verlag, 2001) Pekindil, Y; Sankaya, A; Birtane, M; Pekindil, G; Salan, A[Abstract Not Available]Öğe 99mTc-sestamibi muscle scintigraphy to assess the response to neuromuscular electrical stimulation of normal quadriceps femoris muscle(Japanese Society Nuclear Medicine, 2001) Pekindil, Y; Sarikaya, A; Birtane, M; Pekindil, G; Salan, AObjectives: Neuromuscular electrical stimulation (NMES) is widely used for improving muscle strength by simultaneous contraction in the prevention of muscle atrophy. Although there exist many clinical methods for evaluating the therapeutic response of muscles, Tc-99m-sestamibi which is a skeletal muscle perfusion and metabolism agent has not previously been used for this purpose. The aim of our work was to ascertain whether Tc-99m-sestamibi muscle scintigraphy is useful in the monitoring of therapeutic response to NMES in healthy women. Methods: The study included 16 women aged between 21 and 45, with a mean age of 32.7 +/- 6.4. Both quadriceps femoris muscles (QFM) of each patient were studied. After randomization to remove the effect of the dominant side, one QFM of each patient was subjected to the NMES procedure for a period of 20 days. NMES was performed with an alternating biphasic rectangular current, from a computed electrical stimulator daily for 23 minutes. After measurement of skinfold thickness over the thigh, pre- and post-NMES girth measurements were assessed in centimeters. Sixty minutes after injections of 555 MBq Tc-99m-sestamibi, static images of the thigh were obtained for 5 minutes. The thigh-to-knee uptake ratio was calculated by semiquantitative analysis and normalized to body surface area (NUR = normalized uptake ratio). Results: The difference between the pre and post NMES NUR values was Significant (1.76 +/- 0.31 versus 2.25 +/- 0.38, p = 0.0000). The percentage (%) increase in NUR values also well correlated with the % increase in thigh girth measurements (r = 0.89, p = 0.0000). Conclusion: These results indicated that Tc-99m-sestamibi muscle scintigraphy as a new tool may be useful in evaluating therapeutic response to NMES.Öğe The clinical efficacy of low-power laser therapy on pain and function in cervical osteoarthritis(Springer-Verlag, 2001) Özdemir, F; Birtane, M; Kokino, SPain is a major symptom in cervical osteoarthritis (COA). Low-power laser (LPL) therapy has been claimed to reduce pain in musculoskeletal pathologies, but there have been concerns about this point. The aim of this study was to evaluate the analgesic efficacy of LPL therapy and related functional changes in COA. Sixty patients between 20 and 65 years of age with clinically and radiologically diagnosed COA were included in the study. They were randomised into two equal groups according to the therapies applied, either with LPL or placebo laser. Patients in each group were investigated blindly in terms of pain and pain-related physical findings, such as increased paravertebral muscle spasm, loss of lordosis and range of neck motion restriction before and after therapy. Functional improvements were also evaluated. Pain, paravertebral muscle spasm, lordosis angle, the range of neck motion and function were observed to improve significantly in the LPL group, but no improvement was found in the placebo group. LPL seems to be successful in relieving pain and improving function in osteoarthritic diseases.Öğe Cognitive evaluation and functional outcome after stroke(Lippincott Williams & Wilkins, 2001) Özdemir, F; Birtane, M; Tabatabaei, R; Ekuklu, G; Kokino, SObjective: To investigate the initial overall cognitive ability and its components as a predictor of functional improvement and ambulation during rehabilitation. Initial cognitive status is widely known to be a predictive factor in functional recovery in patients with stroke although some reports have found no such relationship. Design: Baseline cognitive status was scored by Minimental State Examination and its subsections with such headings as orientation, registration, attention and calculation, recall, and language in 43 patients with postacute stroke, aged between 51 and 68 yr. Function was evaluated in terms of motor FIM(TM) and functional ambulation as categorized in Adapted Patient Evaluation and Conference System functional scale at the time of admission and discharge. Results: Only total baseline Minimental State Examination score showed a significant correlation with discharge motor FIM improvement (r = 0.31, P = 0.04) and baseline orientation score correlated significantly with functional ambulation score improvement (r = 0.31, P = 0.03). In stepwise linear regression model, the same Variables had an effect on similar outcome parameters. Conclusions: Cognitiveion evaluation should be taken as a whole to predict functional outcome in patients with postacute stroke, except for the baseline orientation score that seemed more predictive for ambulation.Öğe Comparing stroke rehabilitation outcomes between acute inpatient and nonintense home settings(W B Saunders Co-Elsevier Inc, 2001) Özdemir, F; Birtane, M; Tabatabaei, R; Kokino, S; Ekuklu, GObjective: To compare outcomes in stroke survivors who received rehabilitation services in an acute inpatient rehabilitation setting (multidisciplinary rehabilitation team) with outcomes in survivors in a home-based setting (family caregivers, limited team supervision). Design: Randomized clinical trial, with mean follow-up after 60 days. Setting: Inpatient rehabilitation setting and home-based settings. Patients: Sixty patients (age range, 43-80yr) who had a stroke between 1996 and 1999 and had been referred after medical stabilization, randomly divided into 2 groups: group 1, inpatient rehabilitation; group 2, home-based rehabilitation. Interventions: Group 1: therapeutical and neuromuscular exercises with occupational therapy with professional supervision; group 2: conventional exercises with family caregiver and limited professional supervision. Main Outcome Measures: Spasticity was evaluated with the Ashworth Scale, motor status with Brunnstrom's stages, functional status with the FIMTM instrument, and cognitive status with the Mini-Mental State Examination before and after rehabilitation. Results: Patients rehabilitated in acute inpatient settings had better motor, functional, and cognitive outcomes (p < .05). Spasticity changes did not differ between the groups. Conclusion: Intense inpatient rehabilitation services for stroke survivors provide significantly more favorable functional and cognitive outcomes with relatively low complications than did nonintense rehabilitation efforts in home settings.Öğe The diagnostic value of magnetic resonance imaging in subacromial impingement syndrome(Yonsei Univ Coll Medicine, 2001) Birtane, M; Çalis, M; Akgün, KThe aim of this study was to assess the diagnostic ability of magnetic resonance imaging (MRI) in subacromial impingement syndrome (SIS), using a physiological standard of reference. MRI of the rotator cuff (RC) and subacromial injection test (SIT), a reference standard for SIS diagnosis, were performed in 125 painful shoulders. MRI diagnostic accuracies were determined using a 2 x 2 table and the percentage values of SIS diagnosis in patients with the three Zlatkin NM stages were determined. Shoulder function was evaluated using the Constant Scale, and results were compared for stages. The sensitivity, specificity, accuracy, positive and negative predictive values of MRI for SIS diagnosis were 98.85%, 36.84%, 80%, 78.18% and 93.33% respectively. Of the 32 patients with Zlatkin stage 1 changes in MRI, 20 (62%) had SIT approved SIS diagnosis, while 47 (79%) of the 59 patients with Zlatkin 2 and all of the 19 (100%) patients with Zlatkin 3 changes were diagnosed with SIS by SIT. Mean Constant scores were 78.04 +/- 18.3, 65.0 +/- 19.9 and 54.52 +/- 20.7 in patients with Zlatkin stages 1, 2 and 3, respectively (p < 0.05). The MRI of RC did not prove to be an excellent tool for SIT based SIS diagnosis, with its low specificity. However, the technique can give important clues, as its sensitivity and negative predictive values are high.Öğe Diagnostic values of clinical diagnostic tests in subacromial impingement syndrome(Bmj Publishing Group, 2000) Çalis, M; Akgün, K; Birtane, M; Karacan, I; Çalis, H; Tüzün, FObjective-Subacromial impingement syndrome (SIS) is a frequent cause of shoulder pain. The aim of this study was to investigate the diagnostic values of clinical diagnostic tests, in patients with SIS. Methods-72 female, 48 male patients with shoulder pain were included in the study. Five had bilateral shoulder pain, so 125 painful shoulders were evaluated. Details were recorded about the patients' ages and sexes, as well as characteristics of pain and related problems. Detailed physical examination and routine laboratory tests were performed. Conventional radiography and subsequent magnetic resonance imaging of the shoulder region of all patients were performed. Patients were divided into two groups according to the results of subacromial injection test, a reference standard test for SIS. Test positive patients constituted SIS group and test negative patients the non-SIS group. Sensitivity, specificity, accuracy, positive and negative predictive values of some clinical diagnostic tests such as Neer, Hawkins, horizontal adduction, painful are, drop arm, Yergason and Speed tests for SIS were determined by using 2 x 2 table. Results-The most sensitive diagnostic tests were found to be Hawkins test (92.1%), Neer test (88.7%) and horizontal adduction test (82.0%). Tests with highest specificity were drop arm test (97.2%), Yergason test (86.1%) and painful are test (80.5%) consecutively. Conclusion-The highly sensitive tests seem to have low specificity values and the highly specific ones to have low sensitivity values. Although this finding suggests that these diagnostic tests are insufficient for certain diagnosis, it is suggested they play an important part in clinical evaluation.Öğe Dysphagia induced by a cervical osteophyte: a case report of cervical spondylosis(Chinese Medical Association, 2004) Uzunca, K; Birtane, M; Tezel, A[Abstract Not Available]Öğe Efficacy of low level laser therapy in myofascial pain syndrome(Wiley, 2003) Hakgüder, A; Birtane, M; Gürcan, S; Kokino, S; Turan, FNBackground and objectives: The efficacy of low level laser therapy (LLLT) in myofascial pain syndrome (MPS) seems controversial. Our aim was to clarify the effect of LLLT in MPS by using algometry and thermography. Study Design/Materials and Methods: Sixty-two patients with MPS having an active trigger point in the neck or upper back region were randomly divided into two equal groups according to therapy applied (group 1: LLLT + stretching exercises, group 2: stretching exercises alone). The outcome measures were pain measured with visual analogue scale (VAS), algometry on the trigger point, algometric difference, thermographic difference, and thermal asymmetry. Comparison was made within and between the groups pre- and post-therapeutically and 3 weeks after therapy. Results: Mean pain values decreased more significantly in group 1 from baseline to 3 weeks followup, (7.54-3.06) while these values were 7.03-5.19 in group 2 (P < 0.05). Group comparisons revealed significant favorable differences in group 1 patients in terms of all other parameters at the first and the second evaluation post therapeutically (P < 0.05). Conclusions: LLLT seemed to be beneficial for pain in MPS by using algometry and thermography. (C) 2003 Wiley-Liss, Inc.Öğe The evaluation of plantar pressure distribution in obese and non-obese adults(Elsevier Sci Ltd, 2004) Birtane, M; Tuna, HBackground. Although previous studies have generally reported increased plantar pressure values with obesity, none of these studies has classified the obesity. Our aim in this study was to compare the plantar pressure distribution in obese and control adults during standing and walking. Methods. This study was performed on 100 feet of 50 study participants. The subjects gathered in two groups, each containing 25 study participants, as non-obese and class I obese according to their body mass index values. Static and dynamic pedobarographic evaluations were performed during standing and walking. The findings were compared between the groups and also the correlation of body mass index with the pedobarographic parameters was assessed. Findings. The static pedobarographic evaluation revealed significantly higher values in terms of forefoot peak pressure, total plantar force and total contact area in the feet of class 1 obese subjects when only middle foot peak pressure was found to be higher in class 1 obese subjects than controls as a dynamic pedobarographic parameter. Among the static parameters body mass index was found to have positive correlation with total plantar force (r = 0.50, P = 0.000) and total contact area (r = 0.33, P = 0.019). Only middle foot peak pressure (r = 0.32, P = 0.025) among the dynamic pedobarographic parameters had positive correlation with body mass index. Interpretation. This study may be a first step to evaluate the effect of different obesity categories on the plantar pressure values. Further studies are needed to investigate the effect of different obesity grades. (C) 2004 Elsevier Ltd. All rights reserved.Öğe Evaluation of skeletal muscle metabolism and erythropoietin treatment response in patients with chronic renal failure with 99mTc-sestamibi leg scintigraphy(Springer Verlag, 1999) Sarikaya, A; Sen, S; Çermik, TF; Birtane, M; Berkarda, S[Abstract Not Available]Öğe Evaluation of skeletal muscle metabolism and response to erythropoietin treatment in patients with chronic renal failure using 99Tcm-sestamibi leg scintigraphy(Lippincott Williams & Wilkins, 2000) Sarikaya, A; Sen, S; Çermik, TF; Birtane, M; Berkarda, SIt is well known that uraemia affects skeletal muscle metabolism. This has been attributed to a variety of causes, including anaemia, vitamin D, carnitine deficiency and hyperparathyroidism. The aim of this study was to ascertain whether Tc-99(m)-sestamibi leg scintigraphy is useful in the evaluation of skeletal muscle metabolism and the monitoring of treatment response in uraemic myopathy. Forty patients with chronic renal failure and 24 normal controls underwent examination. Fifteen patients with chronic renal failure received erythropoietin treatment. Tc-99(m)-sestamibi leg scintigraphy was performed in all subjects and in 15 patients after therapy. The calf-to-ankle uptake ratio was calculated by semi-quantitative analysis and normalized to lean body mass. The normalized uptake ratios were significantly different between patients and controls. After erythropoietin therapy, there was a significant increase in the normalized uptake ratios compared with pre-therapy. Our results suggest that Tc-99(m)-sestamibi leg scintigraphy is useful in the assessment of muscle metabolic abnormalities and the effect of treatment in uraemic myopathy. ((C) 2000 Lippincott Williams & Wilkins).Öğe Evaluation of the late neurologic deficits accompanied by hypertrophic scars and keloids in children with elbow fractures(Lippincott Williams & Wilkins, 2001) Gürbüz, H; Birtane, M; Yalçin, ÖIn this study, the relation between hypertrophic scar and keloid (HSc) lesions around incisions and late neurologic deficits was investigated in operated elbow fractures in children. Six elbow fracture patients with HSc lesions were evaluated for neurologic deficits with late onset. The fractures were all closed and treated with open reduction and internal fixation. No neurologic deficit was detected before surgery and in the early postoperative periods. Late neurologic deficits observed in these patients were evaluated according to British Medical Research Committee scoring scale on admission and after therapy. In the reoperations for neurologic deficits, the nerve segments were found to be compressed in intensive scar tissue. Typical pseudoneuromas were observed in the proximal part of compression; however, the corporal integrity of the nerves was not interrupted. External neurolysis were performed in all patients. Excellent improvements in sensory and motor functions were detected and no recurrence occurred in followup. Elbow fracture patients, especially those with HSc lesions around their incisions, should be followed up for possible neurologic deficits with late onset.Öğe High bone mineral density in loaded skeletal regions of former professional football (soccer) players: what is the effect of time after active career?(B M J Publishing Group, 2005) Uzunca, K; Birtane, M; Durmus-Altun, G; Ustun, FObjectives: Physical exercise is an important factor in the acceleration and maintenance of bone mineral density (BMD). Football is an impact loading sport and some studies demonstrate its site specific, bone mass increasing effect. We compared BMD at different skeletal regions in a group of former professional football players and in normal control subjects and evaluated the effect of demographic factors and time after active career on BMD. Methods: Twenty four former football players,70 years old who had retired from professional football at least 10 years previously and 25 non- athletic controls were recruited. The demographic characteristics, activity levels, and dietary habits of all subjects and the chronological history of the footballers' professional careers were noted. BMD was measured by DEXA at the calcaneus and distal tibia and at the lumbar spine, proximal femur, and distal and proximal radius, and compared between groups. Stepwise multiple linear regression analysis was used to determine the probable predictors of BMD in former football players. Results: In former players BMD values were found to be significantly higher at the lumbar spine, femur neck, femur trochanter, distal tibia, and calcaneus, but not at Ward's triangle ( femur) or the distal and proximal radius regions compared with controls. Time after active career was the only independent predictor of BMD at the lumbar spine, proximal femur ( neck, trochanter, and Ward's triangle), and distal tibia. Conclusions: Former footballers had higher BMD at weight loaded sites and time after active career seemed to be an important factor in determining BMD.Öğe Is local subacromial corticosteroid injection beneficial in subacromial impingement syndrome?(Springer London Ltd, 2004) Akgün, K; Birtane, M; Akarirmak, ÜSubacromial corticosteroid injection is one of the most frequently used management tools in subacromial impingement syndrome (SIS) despite controversial reports on the efficacy. Our purpose, in this single blinded, randomised and controlled study was to clarify whether the corticosteroid injection provides additional benefit when used with other conservative treatment modalities in 48 patients with stage 2 SIS. The patients were randomly divided into three groups according to the two therapeutic injections applied with a 10-day interval: group 1: 10 cc of 1% lignocaine + 40 mg of methylprednisolone for the first and second injections, group 2: 10 cc of 1% lignocaine + 40 mg of methylprednisolone for the first injection and only 10 cc of 1% lignocaine for the second injection, group 3: only 10 cc of 1% lignocaine for the first and second injections. All the patients were prescribed 500 mg of naproxen sodium to use two times daily, instructed to rest and perform Codman's pendulum exercises during the first 15 days. Shoulder pain during rest, activity, and causing disturbance of sleep was evaluated using a visual analogue scale and shoulder function was investigated by total Constant score and its subsectional parameters which are pain, daily living activities, active range of motion and strength before the therapy and 1 and 3 months after the therapy onset. Significant improvements from the baseline values in all pain and function parameters were observed at the first and second evaluation in all groups. Group 1 patients had more favourably improved values in pain causing sleep disturbance and daily living activity parameters than group 2 and 3 patients only in the 1st month after therapy onset. We found that subacromial corticosteroid injections in the acute or subacute phase of SIS provided additional short-term benefit without any complication when used together with nonsteroidal anti-inflammatory drugs ( NSAIDs) and exercise.Öğe Pedobarography and its relation to radiologic erosion scores in rheumatoid arthritis(Springer Heidelberg, 2005) Tuna, H; Birtane, M; Tastekin, N; Kokino, SThe aim of this study was to assess probable plantar pressure alterations in rheumatoid arthritis (RA) patients by comparison with normal subjects and to investigate the probable relation between pressure distribution under the foot and radiologic foot erosion score. Two hundred feet of 50 chronic RA patients and 50 healthy controls were evaluated. Static and dynamic pedobarographic evaluations were used to define the plantar pressure distribution. Also, the modified Larsen scoring system was used to detect the staging of erosions on feet radiograms of the RA patients. Static pedobarography revealed higher pressure and contact areas in the forefoot. All dynamic pedobarographic parameters except for plantar contact area were significantly different between the RA patients and control subjects. Patients with high erosion scores had higher static forefoot and dynamic phalanx peak pressure values. Pedobarographic investigation can be useful to evaluate pressure distribution disorders in RA feet and may provide suitable guidelines for the design of various plantar supports.Öğe Pressure-induced pain on the tibia: an indicator of low bone mineral density?(Springer Tokyo, 2004) Birtane, M; Tuna, H; Ekuklu, G; Demirbag, D; Tuna, F; Kokino, SPrevious literature investigating bone pain in osteoporosis has prominently focused on painful conditions following osteoporotic fractures. Is osteoporosis really a silent disease without bone pain and tenderness unless a fracture occurs? Our aim in this study was to answer the question by assessing the questionable tenderness on tibia bones of fracture-free patients with low bone density and to compare the findings with a normal population. One-hundred-thirty-three consecutive postmenopausal female patients with the mean age of 56 years admitted to our clinic for bone mass measurement were included in the study. Bone mineral density (BMD) values of lumbar spine (L2-L4) and right proximal femur (neck, trochanter, Ward's triangle) were measured by dual-energy X-ray absorptiometry (DXA). Patients with T scores lower than -1 formed the osteopenic-osteoporotic group of patients (low BMD group) whereas those with T scores higher than -1 constituted the normal BMD group according to the osteoporosis definition regarding T score for DXA. Mechanical pressure was applied by a hand algometer on the middle points of three equally divided sections on the anterior part of tibia, and the pressure levels starting the pain sensation (POPL) were recorded. Although the patients in the normal BMD group reported consistently high POPL at all regions of tibia for all BMD measurement sites, this difference reached to a statistical significance level only for the femur neck region. Only mean POPL for the whole tibia had independent association with only femur neck BMD by multiple linear regression analysis. These results are encouraging for assessing the significance of pressure-induced tibial pain as an indicator of low BMD in the future.Öğe Tc99m sestamibi muscle scintigraphy to assess the response to electrical stimulation and isometric exercise of quadriceps femoris muscle(Springer-Verlag, 2001) Pekindil, Y; Birtane, M; Sankaya, A; Salan, A; Kokino, S[Abstract Not Available]Öğe Which of the three different tender points assessment methods is more useful for predicting the severity of fibromyalgia syndrome? [Meeting Abstract](Bmj Publishing Group, 2005) Tastekin, N; Birtane, M; Uzunca, K[Abstract Not Available]
